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Gout as a risk factor for acute myocardial infarction: evidence from competing risk model analysis
  1. Chia-Luen Huang1,
  2. Tai-Wen Wang2,
  3. Yong-Chen Chen3,
  4. Je-Ming Hu4,
  5. Po-Ming Ku5,
  6. Chang-Hsun Hsieh1,
  7. Chien-Hsing Lee1,
  8. Feng-Chih Kuo1,
  9. Chieh-Hua Lu1,
  10. Cheng-Chiang Su1,
  11. Jhih-Syuan Liu1,
  12. Fu-Huang Lin2,
  13. Yu-Ching Chou2,
  14. Chien-An Sun6
  1. 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
  2. 2School of Public Health, National Defense Medical Center, Taipei City, Taiwan
  3. 3Department of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
  4. 4Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
  5. 5Department of Cardiology, Chi-Mei Medical Center, Tainan City, Taiwan
  6. 6Department of Public Health, Fu-Jen Catholic University College of Medicine, New Taipei City, Taiwan
  1. Correspondence to Dr Chien-An Sun, Department of Public Health, Fu-Jen Catholic University College of Medicine, New Taipei City 24205, Taiwan; 040866{at}mail.fju.edu.tw

Abstract

Chronic inflammation, a hallmark of gout, is implicated in the pathogenesis of atherosclerosis. Thus, in theory, gout can be expected to increase the risk of acute myocardial infarction (AMI). Yet, results from several epidemiological studies have been inconclusive. A retrospective cohort study was conducted using the National Health Insurance Research Database of Taiwan dated from 2000 to 2013. The study cohort comprised 3581 patients with gout (the gout cohort) and 14,324 patients without gout (the non-gout cohort). The primary outcome was the incidence of AMI. To estimate the effect of gout on the risk of AMI, the Lunn-McNeil competing risk model was fitted to estimate cause-specific hazard ratios (HRs) and their 95% confidence intervals (CIs). The cumulative incidence of AMI was significantly higher in the gout cohort than in the non-gout cohort, resulting in an adjusted HR of 1.36 (95% CI 1.04 to 2.76). Further, HRs of gout with incident AMI were higher in patients without hypertension, diabetes mellitus, or hyperlipidemia (ranging from 1.63 to 2.09) than in those with each of these comorbidities (ranging from 0.95 to 1.13). The results of this study suggest that patients with gout have an increased risk of AMI. The AMI risk associated with gout was conditional on patients’ cardiovascular risk profile. Future work is needed to confirm these findings.

  • atherosclerosis
  • cardiology

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Footnotes

  • Contributors C-LH was responsible for study design and drafting of the manuscript. T-WW was responsible for statistical analyses. P-MK was responsible for resources and funding. J-MH, C-HH, C-HLe, F-CK, C-HLu, C-CS, J-SL, F-HL and Y-CChe were responsible for study supervision, investigation and writing–review and editing. Y-CCho was responsible for data curation. C-AS directed the study implementation, including quality assurance and control and final approval of manuscript. All authors commented on the draft, contributed to the interpretation of the findings and approved the manuscript.

  • Funding This study was supported by a grant from the Chi-Mei Medical Center (107-CM-FJU-06).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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